NPI age
20 years
Enumerated 2006-04-13
Across 245 active psychiatry & neurology providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 5654-9 | BLUE CROSS |
| 01 (ID) | 000010004477 | BLUE SHIELD |
| 05 (CA) | 000390401 |
Solo or small practice. No other active providers share this practice address in NPPES. This provider is listed as a sole proprietor.
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